## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : 

# l^^M U Date : 

# 1 

# U l Address : 

# \^'\^ 

# ^H- & hi t Remediatio nContractor : _Coflsta I Environmenta l Group _ Year ; 20 i 

## 06 ^ 

# A A A
-e ' -a 

# A A A l A SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Stimmar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmationdata Photograph s V 1 ^ W> ^ (^(>T/<<1fl<yv A^ (| ^ j^^i^-Ti- ^ As-built sketch Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedb y EP A Descriptio no f area s not meetin g RO D cleanup criteri a Utilit y clearance s Propert y infonnatio nfro mDougla s Count y Assessor' s Office

Signature 3005483 5 Superfun d

# vv Propert yAcces s Checklis t Property ID : \Q3^^l f nWORKSTARTE D ON : / / Propert y Address : jQ^,- ) p^|-|(^4 ^ nWOR K COMPELTED ON : / / 

### Owner : \^'^ ^ ^e/\\rUp Renter : Address : Phone : Fax : Cell/Pager : Phone : ^^2 ^ b/I ^ '^'^.'^r Additional Information : Fax : Ceil/Pager jer : A



### nNotificatio nLette r P T Acces s Agreement Q ' Restoratio nAgreement D Topsoi l SampUn g (if applicable ) GDisposa l Sampiin g (i f applicable ) D Garde nSamplin g (i f applicable ) nUtUit y Clearanc e • ^ Video/Photo s (Before ) nVideo/Photo s (During ) D Video/Photo s (After) D Video/Photo s (30-Day )
• 'ffl.JProperty Completio nAgreement t l Fuial Report Ai r Monitorin g (a s appUcable ) D Communit y QCre w On : Results : nCommunit y Q Cre w On : Results :

• Communit y • Cre w On : Results : Sent : / / 

### Signed: ^ /i^/Q ^ 

## Signed: ^ /|3. 0 / / / / / / CaUed : / / 

## On : 1 / 7^ 1 r i On : / / On : / / On : / / 1 

## Signed : _|\/^/e g Issued : / /
/ / 

### By : / / By : / / By : By : 

## ByC C By:jr C By : By : By : By : 

### By : (^^^M\^^ \ By : By : By : By : By :

Omah a Lea d Sit s 

### 1• • 

### Dougla s County Accovm t I

j [^||tt|io n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R073457000 2 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VJewO n Ma p Informatio n i s vali d a s o f2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->->••Aut o Sale s Searc h Owne r GENTRU P KEIT H P ETA L T R 193 7 PAR KAV E OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 345 7 000 2 0 7 Accoun t Type : Residentia l Parce l Number : 073457000 2 Parce l Address : 193 7 PAR KA V OMAH AN E 68105-000 0 Lega l Description : BUR R OA KAD D LO T5 6 BLOC K0 AL L LOT S 54-5 5 & 150X15 0 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $14,600.0 0 $14,600.0 0 $14,600.0 0 $14,600.0 0 $14,600.0 0 $14,600.0 0 Improvemen t $134,800.0 0 $134,800.0 0 $134,800.0 0 $128,100.0 0 $128,100.0 0 $128,100.0 0 Tota l $149,400.0 0 $149,400.0 0 $149,400.0 0 $142,700.0 0 $142,700.0 0 $142,700.0 0 Sale s Informatio n Sale s Date : 2007-12-0 5 Dee d Type : Price : Q C $0.0 0 Booilr : 200 7 Page : 13899 8 Grantor : GENTRU P KEI T H P ETA L Grantee : GENTRU P KEI T H P ETA L T R Valid/lnvaiid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 

### 2000-06-0 9 Dee d Type : Price : Grantor : W D $141,000.0 0 Book : 215 5 Page : 03 9



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 9/17/200 9• • 

### Dougla s County Accoun t I

ja^^rvm^o n 

### Pag e 2 o f 3
Grantee : Valid/Invalid : \ vali d Exclusio n Reason : Sale s Date : 1999-03-2 9 Dee d Type : D Book : 211 7 Page : 33 5 Price : $60,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.5 1 22500. 0 1. 0 150. 0 150. 0 N o Improvemen t Informatio n Buildin g 1 193 7 Par * « v Detache d Secon d PIOO T Garag e « „ 8840S 4 Ft 576. 0 Sq.F l

fS L Firs t Floo r 88 4 0 Sq
. Ft 2 Stor y •»??:'? ' Basemen t pe rAppraise r36 4 sof t ftVfH^Hiiiawfiia a CLIC KT O ENLARG E IMAG E CUCKjrOE N LARG E JMAG E Squar e Footage : 1768. 0 Percen t Complete : 100.0 % Perimete r\ 0. 0 Quality : I Goo d Uni t Type : Condition : i Goo d

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Masonr yCommo n Bric k Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Cla yTil e Bedrooms : 4. 0

Roo fType : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k 

### http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 9/17/200 9• • 

## Douglas Count y Accoun t I|||n|ntio n Pag e 3 of3 Sprinkle rSquar e Footage : 0. 0 Yea rBuil t 192 2 Detai l Typ e Applianc e Applianc e Basemen t Fixtur e Fixtur e Fixtur e Garag e Garag e Porc h Porc h Porc h Yea r Remodele d 200 1 Percen f Remodele d 0 % Detai l Descriptio n Allowanc e Fireplac e Masonr y Bsmn t Bloc k 8 f t Additiona l Fixture s Bas e Fixture s Bat h Ful l Basemen t Singl e Detache d En d Soli d Wal l Sla b RoofCei l Sla b RoofCei l Adjuste d Yea r Physica l Ag e Buil t 192 2 8 6 Unit s 1. 0 1. 0 884. 0 1. 0 1. 0 1. 0 1. 0 576. 0

28. 0 72. 0 32. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07.. . 9/17/2009• • • •


## CONTACT FOR M Propert y I D #\'^^^l o Propert y Address : 

# \o^oy , Vx^Y-p. A Initial Contact : Date:^// ^ Time : Secon dContact : Date : Time : Fina l Contact : Date ; Time : Fina l Action : Transmit to EP AD

. 

## Comment : Owner Comment (s) : Site Coordinato r Comment (s) : Action : Action : Action : Other Action : D• • • • 

### Pag e 1 of 2

[ Creat e Anothe rTicke t | [ Bac k t o Irt h Interne t [ Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2369190 . Origina l Cal l Date : 9/21/0 9 Time : 5:3 1 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/23/0 9 Time : 6:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 193 7 Street : PAR K AV E Twp : 15 NRng : 13 E Sect-Qtr : 28-NE-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL3 COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT YO FOMAHA-TRAFFICSEWE RRO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. , . 9/21/200 9

### Pag e 2 of 2 • • • • 

### 0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/21/200 90LS# : 1834 6 Dat e Excavated : 10/9/0 9 

# As-Buil t Drawin g Dat e USEP ASigne d Off : 11/5/0 9 COASTA L Are a Sodden : 963 9 s o f t 

# Omah aLea dSuperfun dSit e

8 2 = 10 5 PP M @ 13 " Ai rConditione r

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d Are a replace d wit h Rock/Mulc h Are a lef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

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## Coinsen l fo rAcces s T o PropsFt y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representati\'es , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : 

# (V P Dd^e S^l- m Owner' s Mame : Daytim e Phon e 

# i- ^ h^r^^ p
Addres s o fPropert y covere d b ythi s Agreement : 

# 1^^ 1 VaxV - t^f^ PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o its origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2Jl * * > 

# 1. ^ \:^.-fyi^^ / COA.STA L IHYIROHMtKTl t CROU P IH C 

### \ A i Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; « Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; c : Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; e I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. cAllo wvideotapin g and/o rphotographin g o fth e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property' , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac l Coasta l Environmenta l Group , a t (402 ) 991-119 9
I gran t acces s t o m ypropertie s Q I d o no t gran t access t o m ypropertie s 

# % ^ fj/yc ^ Signature Dat e Signature Dat e
Q I woul d lik e t o b e presen t durin g an ysampling i tha t i s required
.

Pag e 2 o f2COASTA L 

## Restoraliisoi aAgireemen t Th e purpos e o f thi s agreemen i i s t o provid e amutua J agreemen t a s t o condition s ofth e properl y prio r to remediatio nactivities . Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio nofth e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) . fPropert y ID : [ y g^4( ^

Propert y Address : ^Q•2,- 7 ^^CkSc ^ KJ ^ Owner : "^rW\C-^^XS-W^y Q Phone : 

# iaX^LZ^jh^ ^ .Js^JOod^^jZM^
- i\ia^,..„^. ^ O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) to b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y andVideographicaJl y documen t the existin g condition s o f lhe property andth e basemen t if necessary . 

### item s to b e Remove db y th e Owne r befor e Star t o

f Remediation : The ranoval . storage , disposal , and/o r retur nofthes e itom s I s th e Owner' s responEibiiity . 

# UrMi L Item : Item : Item ;



### Item s t o b e Remove db y the^ontracto r Durin g Remediatio nan di\}o t Repjaced ^ Item : 

# \i m Item : Item : Item :

^ Pag e 1 o fCOASTA L 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Repiace d Item : 

# s^i f&- ^ Item ; 

## ' g ^ \^ ^ ttem : t * Item :



### Ite m Pre-existin g propert y area , that wil l b e excavated , that i s covere dwit hgrass . Nurnbe r o f tree s > 2 inc h trunk diamete r Numbe r o f tree s < - 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Aiiat h; i skcicl i ol the "

• .(•rii'klo i l;!>:ni i Numbe r o f an dsiz e o f eac hgarden / flower be d area . Alli'itli ; i Nkt'icl i o \rk.-!;ilivi
­ • >m-s niidloc;iiiiiii i Agree dupo nvalu e o f plan t material s no t t o b e replace db y contractor . N'Ci c llii ' ^Hlll C v\ill H i i;six ' 10 liiu i . 1 ;)lan ; loiifSiL T l o lli e i;ropci-f \ ui i ner . Easemen t Area , to b e excavate d _— . 

### Landscap e Inventor y Quantit y Uni t Condition/Type/Specie s Quadrant s ^ ^



# b Eac h Eac h \
Eac h 

# \\ o

Eac h Squar e Fee t 

### \

$ 

### \

Eac h 

# \^jrClu\ a^€ajV\s

Pag e 2 o f • >. V»>^_;<^S5£^ ' COASTA L

fAdditiona l Comment s / Instructions ; j



# L.

^^Chec k th e bo x ifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e preexistin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r ofhouse , includin g foundatio n crack sorfissures
.
y i I agre e Q I do no t agre e

Sienatur Sienatur • Owner' s s Signatur e e ' ' Dat Dat e e Cbntractor' Cbntractor' s s Signatur e e Dat e Pag e 3 of /_BVID # 

# /^3V^ XR F PROPERTY SAMPL E SHEE T Dat e Addres s 

## l^^ > po^tAA-Ch ^ Project Omah a lead F P 2n d yea ropilo n Sampl e tim e am/p m XRFID # sampl e lengt h 3 0 se c

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

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RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

la b sampl e # La b resul t Sampl e are a XR F Avg
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# Prin t 'PlMfllnp ^ CjtOAe s

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. v J ^ ^ %

. ­ -o * www.coastalhazmat.co m ^•tPf.oit' ^ COASTA L ENVIRONHENTA L C R O U r . IN C 

# EXECUTIV ESUMMARY : BVI D #18346-(193 7 PAR K AVE ) N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

# 0 ^ 1 EP APropert y Clos e Ou t For m Propert y # : \<?l?Pr{LQ . Date/Time : Owner' s Name;..^.,K.t) M .nvAr ^ f ' Quad s Excavattd : [32 . Contracto r Grou p PnQ'^/ l \ Ye s N o Excavatio nGenera l 

# y 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? Ye s N o Gradin g So dan dVegetatio n 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavaie darea s generall y slop e away fromth e house ? 

# TA ^ 2 .Ha s so dbee nlai dinal l area s tha t wer e excavated ? 3 .Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

## y da y tim e period ) 4 .Ar e sodde darea s generall y firman devenl y graded ? 

# y^ 5 .

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

## y ^ tim e period ) 6 , Wa s th e propert y grade dsuc htha t wate r wil l no t poo l onth e property ? 

## y ^ 7 .

Wa s damag e t o landscapin g o r plant material s avoided ? Gates , Fence s an dRetainin g Wall s Ye s No 1 .D o gate s ope nan dclos e freely? (Ifappiicable ) 

# y ' Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifappiicable ) 

# y ^ 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 

# y 

# -y 4 .Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) Foundation , Sidin g an dCutler s Ye s No I .Wa s damag e t o th e sidin g o r tri mavoided ? ^ ^ 2 .Wa s damag e t o Ih e foundatio navoided ? Wa s damag e t o window s avoided ? 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

### ly- ^ 5 .

Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .Wa s damag e t o drivewa y surface s avoided ? y ^ 2 .Wa s damag e t o walkwa y surface s avoided ?

## Ort'ner s comments :

Inspectio nnotes :

Remova l an dreslorationaclivate s complet e including th e 30-da y sodwarranty : EP ARepresenlaliv e Ud> i J%AILDale : / / SA O ?

## Propert yCompletio n Agreenfien t Thi s ajireemen t documeni s lh e compielio n ofremedia l aclivme s perioime d o n m yproperly
. M ysignatur e wil l designal e tha i I a m satisfie d wil h th e restoratio n o fin yproperly , an d tha i n o item s ar e i n questions , now . o ra l an ylim e i n th e future , excep l thos e ilem s hsle d below , ifan y

Propert ym : \ <g)^<-.\V ^ Propert yAddress : \ ( \ -^- ^ Pgr R /V ^ Phone : {. ^ ^^^ ^ ^MPDnA ^ •' 3^^.11 1 ft Restoratio n Item s i n Question : 

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A'^^r/'-'PiAa-
. Item : Item : Item : Item : Item : Additiona l Comments : 

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^ ^/ / 

# L_

I ajjrc cI cstoralio n i « completed , cxccp i a s noler i [ I I rto no t aure crcsioratm ri s compleler i

Owiin' s Signatur e Dat e Contracioi' s Siqnaiur c' Dal e